Information for referring GP’s for all Services

February 2020

Please note with effect from 1st April 2020 that The Palpitation Service will be open to e-RS.  Please refer through this route from this date.

Systemic Lupus

A new service for Systemic Lupus Erythemtosus is now available to refer through e-RS.


January 2020

Happy New Year to all our GP surgery colleagues.

Paediatric Surgery –

Position statement as agreed between Paediatric & Neonatal Surgery NNUH, and Speech & Language Therapists @ NNUHFT

Lingual or Lip Frenulum Division in babies to prevent speech issues:-

Dear GPs/Parents,

We often get requests to restrictive lingual frenulum (tongue tie)  and lip frenulum assessments and divisions for babies with concerns regarding “future speech issues”. This is usually when a family member, health visitor or health professional notice an upper lip or lingual frenulum (tongue tie) as part of routine observations or during assessments for feeding issues.

In absence of any significant feeding issue, assessments or treatment for restrictive lingual frenulum (tongue tie) are neither required nor advisable. In addition, there is no requirement to do divisions for upper lip ties in babies either for feeding, future dentition issues or future speech concerns.

There is no clinical assessment tool or criterion available to any health professional including us to predict “future effect” or either a lip tie or restrictive lingual frenulum (tongue tie) on speech. There is no current evidence to support that a pre-emptive surgical procedure i.e. division of frenulum on a baby for a problem which does not exist yet, and may never exist, can be of benefit. There is also a potential of causing unnecessary trauma, bleeding, and scarring which can then cause further limitations in future.

We therefore, would reject any referrals in first 30 months of life for assessment and treatment for “future concerns with speech” in presence of a lip tie or restrictive lingual frenulum (tongue tie).

We would be happy to review an older child, if speech concerns are reported following an assessment by a Speech and Language Therapist (SLT) and a clear recommendation from a speech therapist that a restrictive frenulum may be potential cause of speech issues in the child and the speech therapist will support the child following a procedure.

Upper Lip Tie Divisions

Position statement as agreed between Maxillo Facial Department, NNUH, Paediatric & Neonatal Surgery NNUH, and Cleft. NET.East

Dear GPs/Parents

We are often getting requests for upper lip tie assessments and divisions in babies, toddlers, and young children. There are concerns being raised by some groups regarding its effect on breastfeeding. There is no evidence to support this. The other worries are its effect on dentition.

To address these concerns, we would like to share our position statement with you and parents who have similar concerns.

The normal position of the upper lip frenulum, at this age is actually on the most prominent part of the alveolus, between the anterior teeth or in midline. This is considered as a normal anatomy and should have no effect on the feeding. This is also likely to migrate upwards particularly as the permanent teeth come through and as the alveolus develops. Therefore, there is usually no clinical indication to do this at a young age. If this should be necessary then the appropriate time is when the permanent teeth have developed, and orthodontic treatment is proceeding, or after the upper permanent canines have erupted.

This is our agreed position with the Oral & Maxillofacial Department at NNUH, as well as Paediatric Dentist based at Addenbrookes Hospital, (Cleft.NET.East)

W would be happy to review, if there are any dental concerns reported following eruption of upper permanent canines. In these situations, we request an assessment and recommendation form a dentist following eruption of the child’s upper permanent canines, prior to referral for consideration of lip tie division. The procedure required general anaesthesia.

Pain Management  

Dear Referrers,

The Pain Service is currently experiencing high levels of referrals, which we are trying as a service to resolve. In the interim, your patience is requested, all patients referred to the Pain Service are in pain and will have equally valid, but very differing reasons for feeling that their pain is different/worse etc than everyone else’s. There is no measure to reduce this subjectivity and therefore we have always treated patients chronologically (with a handful of exceptions) as the only way to fairly manage our service.

We are unable to respond to general expedite letters unless there is a clear clinical change in presentation (excluding worsening pain ).

We hope that you understand whilst we continue to identify ways of reducing our waiting times for appointments there will be some delays.


June 2019

We are pleased to announce additional admin mailboxes have been set up in readiness for the fax switch off. The information is held by Speciality under Information for Referring GP’s.

These mailboxes may be used for existing or named consultant Advice & Guidance referrals, Expedite of follow up appointments. We would ask that the pooled mailboxes are used for all communications and not individual mailbox accounts.

Polite reminder – Please ensure when booking appointments on e-RS through the Ghost clinics route (2ww and Orthopaedics) that the paperwork should not be handed to patients as these are fictitious appointments and the patients will be contacted by NNUH to book into live outpatient clinics.


May 2019

When issuing emails to accounts please insert in the subject box the Speciality and subject header e.g. Ophthalmology Expedite. This ensures we are able to process your request promptly.

Realistic time expectations to patients:-

Please note that Urgent appointments can be waiting from 2-6 weeks depending on the speciality.

Only issue additional information when attaching the referral to e-RS, you can make multiple attachments, we are unable to upload this information until a patient has a relationship with the Trust when they have made an appointment.

Next Generation Text –

Next Generation Text (NGT) – helping people with hearing and speech difficulties communicate with anyone over the phone, using the relay service. Just download within the app.

e-RS worklists:-

Please check your e-RS worklists on a daily basis to avoid any duplication of effort when phoning the Outpatient Booking Services department with any queries or concerns.



Advice and Guidance is available via e-RS for all new patients. Existing or named consultant requests should be submitted direct to the department.

Please see information under each department for specific guidelines when referring to the Trust.



News Update for Referring GPs and Secretaries March 2019

March 2019

Moving forward our latest news update will be viewable on the Trust Web page, go into departments and view Information for referring GPs.   The will be issued every 3 months unless there are any urgent issues or news we need to advise you of.

Additional information will be added to the departments section of the web page, this will be updates, direct referral forms for services not available on e-RS and additional information based on your feedback.


The following services offer Advice and Guidance for NEW patients via e-RS, all other services please contact the department in writing or my NHS net account if set up for that service. 

Breast (General surgery)







General Surgery


Gynaecology (including oncology)




Oral Maxillofacial

Paediatric medicine

Paediatric Surgery

Pain Management






Cromer & NNUH

When referring through e-RS please select both Cromer and NNUH options as these both come under the same umbrella.

Patient Access Standards

We are trying to ensure patients appointment booking and attendance provides them with the most acceptable format of communication or access.  If your patient is known to have any medical, communication or care issues please ensure these are added to the top of the referral.  Getting the information right at the start will improve the whole experience for the patient.

2WW patients

Please ensure you inform 2ww patients that you are referring them under the 2ww rule and they will be contacted, and have an appointment within 2 weeks.


In addition provide your patients with the information card about 2ww appointments

Direct access and referral proformas forms including 2ww

Forms are updated on a regular basis please do not print numerous copies and stockpile.  Out of date forms will be returned if all relevant information has not been provided.  To save extra work please destroy all old forms.

Work lists

Please check your work lists on a regular basis.  Rejections or other information especially on the Dermatology RAS patients will be updated for your reference.

Quadrant Institute

The Quadrant Institute is a new state- of-the-art health research and endoscopy centre.

Endoscopy and Colonoscopy direct referrals should be submitted to their NHS net account


Gastro Unit

Renamed as the Endoscopy Unit

Urogynae Service 

This service is no longer available at Cromer.

Rejected and Downgraded Referrals

The booking team will e-mail downgraded and rejected referrals to your NHS net accounts with effect from 1st April 2019.



Post Directed to the Booking Team at Rouen Road Inappropriately

The examples listed below were received in one day, in many cases multiple numbers of the same issue.  Each item will need to be directed to the correct departments at the Main Hospital or to the specific service mailbox, this will delay patient care.

  • Advice and Guidance for existing patients – this should be issued direct to the speciality not to Rouen Road.
  • Advice and Guidance for a new patient where the service is not set up on e-RS, this should be issued direct to the service in writing, not to Rouen Road.
  • Communication regarding an existing patient, this should be issued direct to the speciality at the Norfolk & Norwich Main Hospital, not via Rouen Road.
  • Follow up appointment request should be directed to the speciality no to Rouen Road.
  • Referrals for consultant led first clinic appointments; these are rejected back to the GP to be booked on e-RS.
  • Direct Booking forms where it states to fax or issue direct to the department via the designated e-mail account.
  • Biomechanics and Speech and language referrals, both which should be issued direct to the service.
  • Response to letters regarding an existing patients letter from NHS to GP this should have been issued direct to the service that issued the letter.
  • Letter to the MRI/Radiology team – this should have been sent direct to the service
  • Letters to service asking for expedite of appointment. This should have been sent to the  This mailbox ensures that new patient expedites are not delayed in the post, they are promptly actioned by the postal team.  Follow up escalations should go direct to the department not to this mailbox.


December & January Recap:

Advice & Guidance

e-RS – New patient Advice and Guidance

Please note e-RS is for NEW patients, not emergency

Emergency Advice or Guidance should be by telephone call direct to the speciality.


Cardiology Advice and Guidance update (please read carefully)

Urgent Advice and Guidance requests should continue to be submitted to the on-call consultant or SPR via Switchboard 01603 286286

New Patient requests should be submitted via e-RS.

ECG advice and guidance and existing/named (not new) consultant request should be submitted via  – please provide a header subject A & G or ECG.

Nephrology Advice and Guidance is now available via e-RS for new patients

Named consultant or existing patient to service Advice and Guidance – ALL SERVICES

Advice and Guidance for patients already under the service should be submitted direct to the service writing (check the web page). Clearly headed ADVICE AND GUIDANCE

Named consultant or existing patients to services A & G requests submitted in error on e-RS will be passed to the consultants in question, as notes need to be obtained the response will not be within 48 hours.  Responses will be issued via clinic letter not on e-RS as this will be added to the patient’s clinical information.   Please contact the named consultant secretary to expedite this information.


With effect from the 1st October 2018, all appointments for consultant led first clinic appointments where services are available on e-RS should be submitted electronically.  Referrals submitted for services which are set up on e-RS will be rejected back to the GP Surgery without being processed.

Direct access services – please submit requests on the relevant proforma which can be located on Knowledge Anglia.

Gastroenterology – Endoscopy

An e-mail account has been set up for direct access proformas


Expedite Appointments – New patients only

New appointment requests to be e-mailed (clearly headed EXPEDITE) 

Follow-up patients only – appointment expedites or queries

In writing direct to the specialty.  Or contact the consultant’s secretary.

Check e-RS before you ring

Please check e-RS in the first instance before you ring the Norfolk and Norwich Outpatient Booking Services department, regarding queries in general & rejections, comments inserted on e-RS normally clarify patients have been contacted.  We are often called for patients who are booked to other providers; this especially applies to patient referrals submitted via RMS.


Second Opinion

Contact the consultant’s secretary

Named consultant Referrals

If your patient has previously been under the care of a specific consultant and wishes to see them again,  if this is added to the content of the clinic letter attached to e-RS it will normally be picked up upon referral triage, if clinically appropriate it will be passed to the specific clinician. Please note waits may be longer for specific named consultants.

Ghost clinic slots

Ghost clinic slots are used for Breast Symptomatic, 2ww, Orthopaedic urgent and Paediatric. These are fictitious slots; therefore please do not give the appointment letter to the patient as it leads to confusion.  Outpatient bookings will convert the ghost slot into an appointment and will contact the patient accordingly.

What post should be sent to Rouen Road Booking team or the mailbox

  • New expedite appointment letters – email only please – SUBJECT OF EXPEDITE
  • Sensitive Data patient appointments ( specify SD APPOINTMENT) specify reason in the e-mail
  • Therapies referrals (dietetics, physio and Occupation therapy) – headed THERAPIES

We would appreciate where possible all communication is e-mailed rather than posted, this also ensures a timely action for your patients.  Please check any pre-populated labels you currently use to direct post to ensure all other post is directed direct to the departments at the Norfolk and Norwich.

RAS Worklists

Please check your RAS worklists regularly for any updated information on your patients.

Accessible Standards     

If your patient has known communication or other needs please let us know at the point of referring.  This enables us to meet the needs of the patient and ensures we can meet their needs for their booking or appointment.  Examples: (deaf, blind, need interpreter, wheelchair access, mental capacity or other special needs).

2WW Breast Appointments


We are continuing to experience a sustained and unprecedented increase in our 2 week wait referrals for Breast services which has been ongoing for 3-4 months. In response to the activity we are putting on additional clinics every week to enable our patients to be seen as quickly as possible. In addition Queen Elizabeth Hospital in Kings Lynn has been accepting referrals on our behalf from patients in the Fakenham catchment area to ease some of the pressure. Longer-term, following some refurbishment work the Breast team will be moving into a new area within surgical outpatients which will provide extra capacity for 2 week wait clinics in the coming weeks.


NHS web page

Search under departments, alphabetical, referring GP information will be available on the front page or on a tab names GP referring Information.  This is in the development stage and more information and referral direct access proforma’s will be added in due course.


New paper referrals to consultant-led services* will be immediately scanned back to the referring GP mailbox without processing, they will be marked as urgent and a read receipt requested.   A dedicated mailbox will be used for you to easily identify these referrals.

Information regarding returns will be provided to the CCGs for ongoing monitoring and training purposes

To clarify 2WW and urgent patients are included in the paper switch off.


Therapy Services News

Referrals for the following services should be sent to:-

  • Physiotherapy
  • Occupational Therapy
  • Dietetics


If you have any queries relating to this move or therapy appointment bookings please contact the team on 01603 289467 or 01603 289290.

If you usually send therapy referrals to your local provider please continue with this process.

Please be aware there are no Occupational Therapy Neurology services based at the NNUH therefore you will need to refer to your usual local community provider for this service.


Additional where to refer information

Excluded from Paper Switch Off Referring Confirmation


Biomechanics Refer direct to Service
Blood transfusions
Breast Screening (annual) Refer direct to Service
Cardiology Fast Track Refer direct to Service
Cardiology Pacemaker Clinic Refer direct to Service
Cardiology Palpitation clinic Refer direct to Service
Cellulitis Clinic (nurse led) Refer direct to Service
Diabetic Eye Screening E-mail direct to service
Diabetic Nurse Facilitators Refer direct to Service
Direct access endoscopy/gastroscopy/dyspepsia Refer direct to Service
DVT clinics
ECG, ECHO, 24hr/48hr/72hr tape only Refer direct to Service
Emergency based Services Refer direct to Service
Eye Casualty

Discuss with Nurse or on-call Dr first

Call 01603 2887787
Eye Polishing Refer direct to OMFT Service
OPMS(Older Persons Medicine – including falls) E-mail to


Genetics Direct to Addenbrooks
Gynaecology Sterilisation – proforma Refer direct to Service
Immunology Refer direct to Service
Neuro Surgery Direct to Addenbrooks
Neurophysiology Tests Refer direct to Service
Obstetrics/Ante-natal related Refer direct to Service
Oncology Refer direct to Service
Orthotics Refer direct to Service
Physiotherapy Refer direct to Service
Podiatry/orthotics Refer direct to Service
Prisons/Opticians and Dentist Referral to be issued to Booking team at Rouen Road by post or E-mail:

Prosthetics Refer direct to Service
T & O Fracture Clinic Refer direct to Service
TIA/Stroke (VTE) Refer direct to Service


For advice or support please contact the following:

System Support for e-RS

Or use the Self Service Portal


0300 1231020
Booking Support 01603 287982
Advice and Guidance Support 01603 286740